Deanna Lane

Scrotal sonography revisited

Sonography is the imaging modality of choice for the scrotum because it is simple, relatively inexpensive, and quick. Recent technological advances and transducer improvements have led to exquisite high‐resolution detail in gray‐scale as well as Doppler imaging. The purposes of this pictorial essay are to review the anatomy and embryology of the scrotal contents and to review the various scrotal and extrascrotal pathologic conditions, including acute scrotum, pediatric and adult testicular and extratesticular scrotal neoplasms, traumatic lesions, and miscellaneous other scrotal lesions.

Timed efficiency of interpretation of digital and film-screen screening mammograms.

OBJECTIVE Our objective was to compare interpretation speeds for digital and film-screen screening mammograms to test whether other variables might affect interpretation times and thus contribute to the apparent difference in interpretation speed between digital mammograms and film-screen mammograms, and to test whether the use of digital rather than film comparison studies might result in significant time savings. MATERIALS AND METHODS Four readers were timed in the course of actual clinical interpretation of digital mammograms and film-screen mammograms. Interpretation times were compared for subgroups of studies based on the interpretation of the study by BI-RADS code, the number of images, the presence or absence of comparison studies and the type of comparison study, and whether the radiologist personally selected and hung additional films; the same comparisons were made among individual readers. RESULTS For all four readers, mean interpretation times were longer for digital mammograms than for film-screen mammograms, with differences ranging from 76 to 202 seconds. The difference in interpretation speed between digital and film-screen mammograms was independent of other variables. Digital mammogram interpretation times were significantly longer than film-screen mammogram interpretation times regardless of whether the digital mammograms were matched with film or digital comparison studies. CONCLUSION In screening mammography interpretation, digital mammograms take longer to read than film-screen mammograms, independent of other variables. Exclusive use of digital comparison studies may not cause interpretation times to drop enough to approach the interpretation time required for film-screen mammograms.

Role of sonography for the locoregional staging of breast cancer

OBJECTIVE This article describes the use of sonography for the locoregional staging of breast cancer. Sonography may identify mammographically occult disease within the breast. Sonography of the regional nodal basins, including the axilla, infraclavicular, supraclavicular, and internal mammary regions, can identify nodal metastases, which may upstage disease and have implications for prognosis. CONCLUSION The anatomy of the regional nodal basins and the TNM staging system for breast cancer are reviewed, and the implications of ultrasound-detected disease on clinical management and treatment decisions are discussed.

Challenges and Potential Pitfalls in Magnetic Resonance Imaging of More Elusive Breast Carcinomas

Breast cancer is a heterogeneous group of diseases caused by differences in the biological, clinical, radiologic, and pathologic features of the different types of invasive carcinoma in the breast. The majority of invasive breast carcinomas are the invasive ductal or no special-type (NST) carcinomas. The rest of the invasive carcinomas are either nonductal carcinoma subtypes or special-type carcinomas, making up 20%-30% of all invasive carcinomas. The latter group comprises very different and distinctive types of cancer with imaging characteristics and challenges that are unique to each subtype. The invasive lobular carcinoma is the most common type of the nonductal carcinomas and can be difficult to detect on imaging because of the distinct pattern of tumor growth in sheets of single file cells with minimal desmoplastic reaction. The mucinous carcinoma of the breast contains extracellular mucin, secreted by the tumor cells. The mucin within these tumors result in imaging features that overlap with benign breast lesions, and may lead to misdiagnosis. Other rare and aggressive breast cancers include metaplastic breast carcinoma and inflammatory breast carcinoma. Both diseases have a poorer prognosis than invasive ductal carcinoma. This article will focus on the rarer non-NST carcinoma of the breast that can be a challenge to assess with imaging, partially related to the unique biology of these cancers.

Detection of Microcalcifications on Digital Screening Mammograms Using Varying Degrees of Monitor Zooming

OBJECTIVE The American College of Radiology recommends that mammogram images be viewed at 100% resolution (also called one-to-one or full resolution). We tested the effect of this and three other levels of zooming on the ability of radiologists to identify malignant calcifications on screening mammographic views. MATERIALS AND METHODS Seven breast imagers viewed 77 mammographic images, 32 with and 45 without malignant microcalcifications, using four different degrees of monitor zooming. The readers indicated whether they thought a cluster of potentially malignant calcifications was present and where the cluster was located. Tested degrees of zooming included fit screen, a size midway between fit screen and 100%, 100%, and a size slightly larger than 100%. RESULTS Readers failed to detect 17 clusters of malignant calcifications with fit-screen images, 12 clusters with midway images, 13 clusters with 100% images, and 11 clusters with slightly larger images. When viewing images without malignant microcalcifications, the readers marked false-positive areas on 25 images using fit-screen images, 43 of the midway images, 40 of the 100% images, and 29 of the slightly larger images. CONCLUSION All four tested levels of zooming functioned well. There was a trend for the fit-screen images to function slightly less well than the others with regard to sensitivity, so it may not be prudent to rely on those images without other levels of zooming. The 100% resolution images did not function noticeably better than the others.

Effect of Mammography on Marker Clip Migration After Stereotactic-Guided Core Needle Breast Biopsy

OBJECTIVE To determine whether the type of projection used-same as or orthogonal to the projection used during a stereotactic-guided core needle biopsy procedure-to obtain the first view on a 2-view postbiopsy mammogram affects biopsy marker clip migration. PATIENTS AND METHODS We prospectively recruited women scheduled to undergo stereotactic-guided core needle breast biopsy with marker clip deployment and categorized the women randomly into one of the following 2 groups: first view on the postbiopsy mammogram obtained in the same projection as that used during the biopsy procedure (group 1), or first view on the postbiopsy mammogram obtained orthogonally to the projection used during the biopsy procedure (group 2). Masks of the prebiopsy and postbiopsy mammograms were used to determine whether and how far the biopsy marker clip moved from the biopsy cavity. RESULTS Sixty-two biopsies were performed in 60 patients (mean age = 56 years; range: 30-78 years); 30 women (32 lesions) were randomized to group 1 and 30 women (30 lesions) were randomized to group 2. Marker clip migration occurred in 10 cases in group 1 (20%, <1cm; 30%, 1-3cm; and 60%, >3cm) and 8 cases in group 2 (0%, <1cm; 75%, 1-3cm; and 25%, >3cm). The mean displacement distance was 0.84cm in group 1 and 0.67cm in group 2 (P = 0.83). The mean displacement distance difference was -0.17cm with a 95% bootstrap confidence interval from -0.87 to 0.57cm. CONCLUSION The type of projection used to obtain the first view on the postbiopsy mammogram, relative to that used during the stereotactic biopsy procedure, did not affect biopsy marker clip migration.